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Children's participation in the decision-making process during hospitalization: an observational study
Ingrid Runeson1, Inger Hallström, Gunnel Elander
1Lund University, Sweden. ingrid.runeson@hik.se
Insights
Children
Area of Science:
- Pediatric Healthcare
- Medical Ethics
- Patient Autonomy
Background:
- Children's involvement in healthcare decisions is crucial for their well-being.
- Understanding the extent of pediatric participation in medical decision-making is essential.
Purpose of the Study:
- To describe the degree of children's participation in decisions regarding their own healthcare.
- To assess optimal participation levels and compare them with actual involvement.
- To explore interactions between children, parents, and healthcare staff during decision-making.
Main Methods:
- Observation of 24 pediatric patients (5 months to 18 years) over 135 hours in a university hospital.
- Utilized a 5-point scale to grade children's participation in healthcare decisions.
- Assessed optimal participation levels for each situation.
Main Results:
- Children were not consistently involved in decision-making to the optimal extent.
- Parents sometimes failed to support children in challenging situations.
- Healthcare staff often informed children without offering alternatives or seeking their input.
- No child was forced into decisions beyond their capacity.
Conclusions:
- Children's participation in healthcare decisions is often suboptimal.
- Healthcare professionals must recognize children as autonomous individuals.
- Facilitating children's participation in healthcare decisions is a core duty for staff.
Abstract:
Twenty-four children (aged 5 months to 18 years) who were admitted to a university hospital were observed for a total of 135 hours with the aim of describing their degree of participation in decisions concerning their own care. Grading of their participation was made by using a 5-point scale. An assessment was also made of what was considered as optimal participation in each situation. The results indicate that children are not always allowed to participate in decision making to the extent that is considered optimal. In no case was it judged that a child participated in or was forced to make a decision that was too difficult for the child. The interactions between children, parents and staff were also described in connection with discussions and decision-making processes. This showed that parents do not always support their children in difficult situations and that health care staff often inform children about what is going to happen without presenting alternatives or asking for their views. Staff may, however, find themselves facing an ethical conflict in deciding between supporting a child's view or following hospital routine. It is of great importance that children are looked upon as potentially autonomous individuals and that staff members realize that one of their core duties is to facilitate children's participation in decision making concerning their health care.